Health Net Violet 1 (PPO) offered by Health Net Life Insurance Company Annual Notice of Changes for 2018 You are currently enrolled as a member of Health Net Violet Option 1. Next year, there will be some changes to the plan s costs and benefits. This booklet tells about the changes. You have from October 15 until December 7 to make changes to your Medicare coverage for next year. What to do now 1. ASK: Which changes apply to you Check the changes to our benefits and costs to see if they affect you. It s important to review your coverage now to make sure it will meet your needs next year. Do the changes affect the services you use? Look in Sections 2.5 and 2.6 for information about benefit and cost changes for our plan. Check the changes in the booklet to our prescription drug coverage to see if they affect you. Will your drugs be covered? Are your drugs in a different tier, with different cost sharing? Do any of your drugs have new restrictions, such as needing approval from us before you fill your prescription? Can you keep using the same pharmacies? Are there changes to the cost of using this pharmacy? Review the 2018 Drug List and look in Section 2.6 for information about changes to our drug coverage. Check to see if your doctors and other providers will be in our network next year. Are your doctors in our network? What about the hospitals or other providers you use? Look in Section 2.3 for information about our Provider Directory. H5439_18_011ANOCEOC Accepted 09052017 ANC012690EO00 (PBP 002_011) (5/17) Form CMS 10260-ANOC/EOC OMB Approval 0938-1051 (Expires: May 31, 2020) (Approved 05/2017)
Think about your overall health care costs. How much will you spend out-of-pocket for the services and prescription drugs you use regularly? How much will you spend on your premium and deductibles? How do your total plan costs compare to other Medicare coverage options? Think about whether you are happy with our plan. 2. COMPARE: Learn about other plan choices Check coverage and costs of plans in your area. Use the personalized search feature on the Medicare Plan Finder at https://www.medicare.gov website. Click Find health & drug plans. Review the list in the back of your Medicare & You handbook. Look in Section 3.2 to learn more about your choices. Once you narrow your choice to a preferred plan, confirm your costs and coverage on the plan s website. 3. CHOOSE: Decide whether you want to change your plan If you want to keep Health Net Violet Option 1, you don t need to do anything. You will stay in Health Net Violet Option 1. To change to a different plan that may better meet your needs, you can switch plans between October 15 and December 7. 4. ENROLL: To change plans, join a plan between October 15 and December 7, 2017 If you don t join by December 7, 2017, you will stay in Health Net Violet Option 1. If you join by December 7, 2017, your new coverage will start on January 1, 2018. Additional Resources Please contact our Member Services number at 1-888-445-8913 for additional information. (TTY users should call 711). From October 1 to February 14, you can call us 7 days a week from 8 a.m. to 8 p.m. From February 15 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays. We must provide information in a way that works for you (in languages other than English, in audio, in large print, or other alternate formats, etc.).
Coverage under this Plan qualifies as minimum essential coverage (MEC) and satisfies the Patient Protection and Affordable Care Act s (ACA) individual shared responsibility requirement. Please visit the Internal Revenue Service (IRS) website at https://www.irs.gov/affordable-care-act/individuals-and-families for more information. About Health Net Violet 1 Health Net Life Insurance Company has a contract with Medicare to offer PPO plans. Enrollment in a Health Net Medicare Advantage plan depends on contract renewal. When this booklet says we, us, or our, it means Health Net Life Insurance Company. When it says plan or our plan, it means Health Net Violet 1.
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 1 Summary of Important Costs for 2018 The table below compares the 2017 costs and 2018 costs for Health Net Violet 1 in several important areas. Please note this is only a summary of changes. It is important to read the rest of this Annual Notice of Changes and review the enclosed Evidence of Coverage to see if other benefit or cost changes affect you. Cost 2017 (this year) 2018 (next year) Monthly plan premium* * Your premium may be higher or lower than this amount. See Section 1.1 for details. $116 $116 Deductible Maximum out-of-pocket amounts This is the most you will pay out-of-pocket for your covered Part A and Part B services. (See Section 1.2 for details.) Doctor office visits $220 combined in-network and out-of-network From in-network providers: $2,900 From in-network and out-of-network providers combined: $4,000 In-network Primary care visits: $12 copay per visit. (Deductible waived) Specialist visits: $25 copay per visit. (Deductible waived) Out-of-network Primary care visits: $20 copay per visit. Specialist visits: $40 copay per visit. $195 combined innetwork and out-ofnetwork From in-network providers: $2,900 From in-network and out-of-network providers combined: $4,000 In-network Primary care visits: $12 copay per visit. (Deductible waived) Specialist visits: $25 copay per visit. (Deductible waived) Out-of-network Primary care visits: $20 copay per visit. Specialist visits: $40 copay per visit.
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 2 Cost 2017 (this year) 2018 (next year) Inpatient hospital stays Includes inpatient acute, inpatient rehabilitation, long-term care hospitals, and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the hospital with a doctor s order. The day before you are discharged is your last inpatient day. In-network You pay a $225 copay each day from days 1 through 7 per benefit period, for Medicarecovered inpatient hospital care. You pay a $0 copay each day from days 8 and beyond per benefit period, for Medicare-covered inpatient hospital care. Out-of-network You pay a $250 copay each day from days 1 through 7 per benefit period, for Medicarecovered inpatient hospital care. You pay a $0 copay each day from days 8 and beyond per benefit period, for Medicare-covered inpatient hospital care. In-network You pay a $225 copay each day from days 1 through 7 per benefit period, for Medicarecovered inpatient hospital care. You pay a $0 copay each day from days 8 and beyond per benefit period for Medicare-covered inpatient hospital care. Out-of-network You pay a $250 copay each day from days 1 through 7 per benefit period, for Medicarecovered inpatient hospital care. You pay a $0 copay each day from days 8 and beyond per benefit period, for Medicare-covered inpatient hospital care. Part D prescription drug coverage (See Section 1.6 for details.) Deductible: $95 Copays/Coinsurance during the Initial Coverage Stage: Drug Tier 1 Preferred generic drugs: $10 copay for a one- Deductible: $95 Copays/Coinsurance during the Initial Coverage Stage: Drug Tier 1 Preferred generic drugs: $10 copay for a one-
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 3 Cost 2017 (this year) 2018 (next year) month $5 copay for a onemonth Drug Tier 2 Generic drugs: $20 copay for a onemonth $10 copay for a onemonth Drug Tier 3 Preferred brand drugs: $47 copay for a onemonth $37 copay for a onemonth Drug Tier 4 Nonpreferred brand drugs: $100 copay for a onemonth $90 copay for a onemonth Drug Tier 5 Specialty Tier: month $5 copay for a onemonth Drug Tier 2 Generic drugs: $20 copay for a onemonth $10 copay for a onemonth Drug Tier 3 Preferred brand drugs: $47 copay for a onemonth $37 copay for a onemonth Drug Tier 4 Nonpreferred brand drugs: $100 copay for a onemonth $90 copay for a onemonth Drug Tier 5 Specialty Tier:
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 4 Cost 2017 (this year) 2018 (next year) 31% coinsurance for a one-month (30-day) supply 31% coinsurance for a one-month (30-day) supply Drug Tier 6 Select Care drugs: $0 copay for a onemonth $0 copay for a onemonth 31% coinsurance for a one-month (30-day) supply 31% coinsurance for a one-month (30-day) supply Drug Tier 6 Select Care drugs: $0 copay for a onemonth $0 copay for a onemonth
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 5 Annual Notice of Changes for 2018 Table of Contents Summary of Important Costs for 2018... 1 SECTION 1 We Are Changing the Plan s Name... 6 SECTION 2 Changes to Benefits and Costs for Next Year... 6 Section 2.1 Changes to the Monthly Premium... 6 Section 2.2 Changes to Your Maximum Out-of-Pocket Amounts... 6 Section 2.3 Changes to the Provider Network... 7 Section 2.4 Changes to the Pharmacy Network... 8 Section 2.5 Changes to Benefits and Costs for Medical Services... 8 Section 2.6 Changes to Part D Prescription Drug Coverage... 9 SECTION 3 Administrative Changes... 12 SECTION 4 Deciding Which Plan to Choose... 13 Section 4.1 If you want to stay in Health Net Violet 1... 13 Section 4.2 If you want to change plans... 13 SECTION 5 Deadline for Changing Plans... 14 SECTION 6 Programs That Offer Free Counseling about Medicare... 15 SECTION 7 Programs That Help Pay for Prescription Drugs... 15 SECTION 8 Questions?... 16 Section 8.1 Getting Help from Health Net Violet 1... 16 Section 8.2 Getting Help from Medicare... 16
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 6 SECTION 1 We Are Changing the Plan s Name On January 1, 2018, our plan name will change from Health Net Violet Option 1 (PPO) to Health Net Violet 1 (PPO). You will receive a new ID card in the mail with this new plan name. Also, any new information provided to you regarding your plan will reference the new plan name. SECTION 2 Changes to Benefits and Costs for Next Year Section 2.1 Changes to the Monthly Premium Cost 2017 (this year) 2018 (next year) Monthly premium (You must also continue to pay your Medicare Part B premium.) Optional supplemental benefits monthly premium Package #5: Preventive & Diagnostic Plus Dental PPO Package #6: Comprehensive Dental PPO $116 $116 $15 $15 $39 $39 Your monthly plan premium will be more if you are required to pay a lifetime Part D late enrollment penalty for going without other drug coverage that is at least as good as Medicare drug coverage (also referred to as creditable coverage ) for 63 days or more, if you enroll in Medicare prescription drug coverage in the future. If you have a higher income, you may have to pay an additional amount each month directly to the government for your Medicare prescription drug coverage. Your monthly premium will be less if you are receiving Extra Help with your prescription drug costs. Section 2.2 Changes to Your Maximum Out-of-Pocket Amounts To protect you, Medicare requires all health plans to limit how much you pay out-of-pocket during the year. These limits are called the maximum out-of-pocket amounts. Once you reach this amount, you generally pay nothing for covered services for the rest of the year.
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 7 Cost 2017 (this year) 2018 (next year) In-network maximum out-of-pocket amount Your costs for covered medical services (such as copays and deductibles) from network providers count toward your in-network maximum out-of-pocket amount. Your plan premium and your costs for prescription drugs do not count toward your maximum out-of-pocket amount. $2,900 $2,900 Once you have paid $2,900 out-of-pocket for covered services, you will pay nothing for your covered services from network providers for the rest of the calendar year. Combined maximum out-of-pocket amount Your costs for covered medical services (such as copays and deductibles) from in-network and outof-network providers count toward your combined maximum out-ofpocket amount. Your plan premium does not count toward your maximum out-of-pocket amount. $4,000 $4,000 Once you have paid $4,000 out-of-pocket for covered services, you will pay nothing for your covered services from network or out-of-network providers for the rest of the calendar year. Section 2.3 Changes to the Provider Network There are changes to our network of providers for next year. An updated Provider Directory is located on our website at https://or.healthnetadvantage.com. You may also call Member Services for updated provider information or to ask us to mail you a Provider Directory. Please review the 2018 Provider Directory to see if your providers (primary care provider, specialists, hospitals, etc.) are in our network. It is important that you know that we may make changes to the hospitals, doctors and specialists (providers) that are part of your plan during the year. There are a number of reasons why your provider might leave your plan, but if your doctor or specialist does leave your plan you have certain rights and protections summarized below: Even though our network of providers may change during the year, Medicare requires that we furnish you with uninterrupted access to qualified doctors and specialists. We will make a good faith effort to provide you with at least 30 days notice that your provider is leaving our plan so that you have time to select a new provider.
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 8 We will assist you in selecting a new qualified provider to continue managing your health care needs. If you are undergoing medical treatment you have the right to request, and we will work with you to ensure, that the medically necessary treatment you are receiving is not interrupted. If you believe we have not furnished you with a qualified provider to replace your previous provider or that your care is not being appropriately managed, you have the right to file an appeal of our decision. If you find out your doctor or specialist is leaving your plan, please contact us so we can assist you in finding a new provider and managing your care. Section 2.4 Changes to the Pharmacy Network Amounts you pay for your prescription drugs may depend on which pharmacy you use. Medicare drug plans have a network of pharmacies. In most cases, your prescriptions are covered only if they are filled at one of our network pharmacies. Our network includes pharmacies with preferred cost-sharing, which may offer you lower cost-sharing than the standard cost-sharing offered by other network pharmacies for some drugs. There are changes to our network of pharmacies for next year. An updated Pharmacy Directory is located on our website at https://or.healthnetadvantage.com. You may also call Member Services for updated provider information or to ask us to mail you a Pharmacy Directory. Please review the 2018 Pharmacy Directory to see which pharmacies are in our network. Section 2.5 Changes to Benefits and Costs for Medical Services We are changing our coverage for certain medical services next year. The information below describes these changes. For details about the coverage and costs for these services, see Chapter 4, Medical Benefits Chart (what is covered and what you pay), in your 2018 Evidence of Coverage. Cost 2017 (this year) 2018 (next year) Emergency care In-network and Out-of-Network You pay a $75 copay for each Medicare-covered emergency room visit. You do not pay this amount if you are admitted to the hospital within 24 hours. (Deductible waived) In-network and Out-of-Network You pay a $80 copay for each Medicare-covered emergency room visit. You do not pay this amount if you are admitted to the hospital within 24 hours. (Deductible waived)
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 9 Section 2.6 Changes to Part D Prescription Drug Coverage Changes to Our Drug List Our list of covered drugs is called a Formulary or Drug List. A copy of our Drug List is in this envelope. We made changes to our Drug List, including changes to the drugs we cover and changes to the restrictions that apply to our coverage for certain drugs. Review the Drug List to make sure your drugs will be covered next year and to see if there will be any restrictions. If you are affected by a change in drug coverage, you can: Work with your doctor (or other prescriber) and ask the plan to make an exception to cover the drug. o To learn what you must do to ask for an exception, see Chapter 9 of your Evidence of Coverage (What to do if you have a problem or complaint (coverage decisions, appeals, complaints)) or call Member Services. Work with your doctor (or other prescriber) to find a different drug that we cover. You can call Member Services to ask for a list of covered drugs that treat the same medical condition. In some situations, we are required to cover a one-time, temporary supply of a non-formulary drug in the first 90 days of the plan year or the first 90 days of membership to avoid a gap in therapy. (To learn more about when you can get a temporary supply and how to ask for one, see Chapter 5, Section 5.2 of the Evidence of Coverage.) During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug. Current formulary exceptions will be covered next year unless otherwise indicated on your decision letter. Changes to Prescription Drug Costs Note: If you are in a program that helps pay for your drugs ( Extra Help ), the information about costs for Part D prescription drugs may not apply to you. We sent you a separate insert, called the Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs (also called the Low Income Subsidy Rider or the LIS Rider ), which tells you about your drug costs. If you receive Extra Help and haven t received this insert by September, 30, 2017, please call Member Services and ask for the LIS Rider. Phone numbers for Member Services are in Section 7.1 of this booklet.
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 10 There are four drug payment stages. How much you pay for a Part D drug depends on which drug payment stage you are in. (You can look in Chapter 6, Section 2 of your Evidence of Coverage for more information about the stages.) The information below shows the changes for next year to the first two stages the Yearly Deductible Stage and the Initial Coverage Stage. (Most members do not reach the other two stages the Coverage Gap Stage or the Catastrophic Coverage Stage. To get information about your costs in these stages, look at Chapter 6, Sections 6 and 7, in the enclosed Evidence of Coverage.) Changes to the Deductible Stage Stage 2017 (this year) 2018 (next year) Stage 1: Yearly Deductible Stage During this stage, you pay the full cost of your tier 3 (Preferred Brand), tier 4 (Non-Preferred Brand), and tier 5 (Specialty) drugs until you have reached the yearly deductible. The deductible is $95 During this stage, you pay $10 cost-sharing for drugs on tier 1 (Preferred Generic), $20 cost-sharing for drugs on tier 2 (Generic), and $0 costsharing for drugs on tier 6 (Select Care) and the full cost of drugs on tier 3 (Preferred Brand), tier 4 (Non-Preferred Brand) and tier 5 (Specialty) until you have reached the yearly deductible. The deductible is $95 During this stage, you pay $10 cost-sharing for drugs on tier 1 (Preferred Generic), $20 cost-sharing for drugs on tier 2 (Generic), and $0 costsharing for drugs on tier 6 (Select Care) and the full cost of drugs on tier 3 (Preferred Brand), tier 4 (Non-Preferred Brand), and tier 5 (Specialty) until you have reached the yearly deductible. Changes to Your Cost-sharing in the Initial Coverage Stage To learn how copayments and coinsurance work, look at Chapter 6, Section 1.2, Types of out-ofpocket costs you may pay for covered drugs in your Evidence of Coverage.
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 11 Stage 2017 (this year) 2018 (next year) Stage 2: Initial Coverage Stage Once you pay the yearly deductible, you move to the Initial Coverage Stage. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost. The costs in this row are for a one-month when you fill your prescription at a network pharmacy. For information about the costs for a long-term supply; at a network pharmacy that offers preferred cost-sharing or for mail order prescriptions, look in Chapter 6, Section 5 of your Evidence of Coverage. We changed the tier for some of the drugs on our Drug List. To see if your drugs will be in a different tier, look them up on the Drug List. Your cost for a one-month supply at a network pharmacy: Drug Tier 1 Preferred generic drugs: You pay $10 per prescription. pay $5 per prescription. Drug Tier 2 Generic drugs: You pay $20 per prescription. pay $10 per prescription. Drug Tier 3 Preferred brand drugs: You pay $47 per prescription. pay $37 per prescription. Drug Tier 4 Non - preferred brand drugs: You pay $100 per prescription. pay $90 per prescription. Drug Tier 5 Specialty tier: You pay 31% of the total cost. pay 31% of the total cost. Your cost for a one-month supply at a network pharmacy: Drug Tier 1 Preferred generic drugs: You pay $10 per prescription. pay $5 per prescription. Drug Tier 2 Generic drugs: You pay $20 per prescription. pay $10 per prescription. Drug Tier 3 Preferred brand drugs: You pay $47 per prescription. pay $37 per prescription. Drug Tier 4 Non - preferred brand drugs: You pay $100 per prescription. pay $90 per prescription. Drug Tier 5 Specialty tier: You pay 31% of the total cost. pay 31% of the total cost.
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 12 Stage 2017 (this year) 2018 (next year) Drug Tier 6 Select care drugs: You pay $0 per prescription. pay $0 per prescription. Once your total drug costs have reached $3,700, you will move to the next stage (the Coverage Gap Stage). OR you have paid $4,950 out-of-pocket for Part D drugs, you will move to the next stage (the Catastrophic Coverage Stage). Drug Tier 6 Select care drugs: You pay $0 per prescription. pay $0 per prescription. Once your total drug costs have reached $3,750, you will move to the next stage (the Coverage Gap Stage). OR you have paid $5,000 out-of-pocket for Part D drugs, you will move to the next stage (the Catastrophic Coverage Stage). Changes to the Coverage Gap and Catastrophic Coverage Stages The other two drug coverage stages the Coverage Gap Stage and the Catastrophic Coverage Stage are for people with high drug costs. Most members do not reach the Coverage Gap Stage or the Catastrophic Coverage Stage. For information about your costs in these stages, look at Chapter 6, Sections 6 and 7, in your Evidence of Coverage. SECTION 3 Administrative Changes Process 2017 (this year) 2018 (next year) Ambulance Services Durable Medical Equipment Part D prescription drug coverage Per one-way trip. No charge for more than one trip in a single day. No preferred vendors/manufacturers 30, 60 or 90-day supply fill for Tier 5 drugs Per one-way trip. Preferred vendors/manufacturers 30-day supply fill for Tier 5 drugs
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 13 Process 2017 (this year) 2018 (next year) Monthly premium/part D late enrollment penalty payment options Mail order pharmacy options Pay by check or money order. Have payment automatically withdrawn from your bank account. Have payment taken out of your monthly Social Security check. Have payment taken out of your monthly Railroad Retirement Board (RRB) check. One mail order pharmacy option is available. Pay by check or money order. Have payment taken out of your monthly Social Security check. Have payment taken out of your monthly Railroad Retirement Board (RRB) check. Submit payment to: Health Net Inc. PO Box 748659 Los Angeles, CA 90074-8659 Two mail order pharmacy options will be available: CVS Caremark Homescripts For information about mail order pharmacy options, call Member Services. SECTION 4 Deciding Which Plan to Choose Section 4.1 If you want to stay in Health Net Violet 1 To stay in our plan you don t need to do anything. If you do not sign up for a different plan or change to Original Medicare by December 7, you will automatically stay enrolled as a member of our plan for 2018. Section 4.2 If you want to change plans We hope to keep you as a member next year but if you want to change for 2018 follow these steps:
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 14 Step 1: Learn about and compare your choices You can join a different Medicare health plan, OR You can change to Original Medicare. If you change to Original Medicare, you will need to decide whether to join a Medicare drug plan. To learn more about Original Medicare and the different types of Medicare plans, read Medicare & You 2018, call your State Health Insurance Assistance Program (see Section 5), or call Medicare (see Section 7.2). You can also find information about plans in your area by using the Medicare Plan Finder on the Medicare website. Go to https://www.medicare.gov and click Find health & drug plans. Here, you can find information about costs, coverage, and quality ratings for Medicare plans. Step 2: Change your coverage To change to a different Medicare health plan, enroll in the new plan. You will automatically be disenrolled from Health Net Violet 1. To change to Original Medicare with a prescription drug plan, enroll in the new drug plan. You will automatically be disenrolled from Health Net Violet 1. To change to Original Medicare without a prescription drug plan, you must either: o Send us a written request to disenroll. Contact Member Services if you need more information on how to do this (phone numbers are in Section 7.1 of this booklet). o OR Contact Medicare, at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call 1-877-486-2048. SECTION 5 Deadline for Changing Plans If you want to change to a different plan or to Original Medicare for next year, you can do it from October 15 until December 7. The change will take effect on January 1, 2018. Are there other times of the year to make a change? In certain situations, changes are also allowed at other times of the year. For example, people with Medicaid, those who get Extra Help paying for their drugs, those who have or are leaving employer coverage, and those who move out of the service area are allowed to make a change at other times of the year. For more information, see Chapter 10, Section 2.3 of the Evidence of Coverage. If you enrolled in a Medicare Advantage Plan for January 1, 2018, and don t like your plan choice, you can switch to Original Medicare between January 1 and February 14, 2018. For more information, see Chapter 10, Section 2.2 of the Evidence of Coverage.
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 15 SECTION 6 Programs That Offer Free Counseling about Medicare The State Health Insurance Assistance Program (SHIP) is a government program with trained counselors in every state. In Oregon, the SHIP is called the Senior Health Insurance Benefits Assistance Program (SHIBA). The Senior Health Insurance Benefits Assistance Program (SHIBA) is independent (not connected with any insurance company or health plan). It is a state program that gets money from the Federal government to give free local health insurance counseling to people with Medicare. Senior Health Insurance Benefits Assistance Program (SHIBA) counselors can help you with your Medicare questions or problems. They can help you understand your Medicare plan choices and answer questions about switching plans. You can call the Senior Health Insurance Benefits Assistance Program (SHIBA) at 1-800-722-4134, TTY users should call 711. You can learn more about the Senior Health Insurance Benefits Assistance Program (SHIBA) by visiting their website (https://www.oregonshiba.org). SECTION 7 Programs That Help Pay for Prescription Drugs You may qualify for help paying for prescription drugs. Below we list different kinds of help: Extra Help from Medicare. People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay up to 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not have a coverage gap or late enrollment penalty. Many people are eligible and don t even know it. To see if you qualify, call: o 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; o The Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users should call 1-800-325-0778 (applications); or o Your State Medicaid Office (applications). Prescription Cost-sharing Assistance for Persons with HIV/AIDS. The AIDS Drug Assistance Program (ADAP) helps ensure that ADAP-eligible individuals living with HIV/AIDS have access to life-saving HIV medications. Individuals must meet certain criteria, including proof of State residence and HIV status, low income as defined by the State, and uninsured/under-insured status. Medicare Part D prescription drugs that are also covered by ADAP qualify for prescription cost-sharing assistance through the Oregon CAREAssist program and Washington Early Intervention Program (EIP). For more information on the Oregon CAREAssist program, please go to this website: https://public.health.oregon.gov/diseasesconditions/hivstdviralhepatitis/hivcaretre atment/careassist/pages/forms.aspx. For more information on the Washington Early Intervention Program (EIP), please go to this website:
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 16 http://www.doh.wa.gov/youandyourfamily/illnessanddisease/hivaids/hivcareclien tservices/adapandeip.aspx. For information on eligibility criteria, covered drugs, or how to enroll in the program, please call Early Intervention Program (EIP) at 1-877-376-9316 or 1-360-236-3426. TTY users call 711 (National Relay Service). SECTION 8 Questions? Section 8.1 Getting Help from Health Net Violet 1 Questions? We re here to help. Please call Member Services at 1-888-445-8913. (TTY only, call 711.) We are available for phone calls. From October 1 to February 14, you can call us 7 days a week from 8 a.m. to 8 p.m. From February 15 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays. Calls to these numbers are free. Read your 2018 Evidence of Coverage (it has details about next year's benefits and costs) This Annual Notice of Changes gives you a summary of changes in your benefits and costs for 2018. For details, look in the 2018 Evidence of Coverage for Health Net Violet 1. The Evidence of Coverage is the legal, detailed description of your plan benefits. It explains your rights and the rules you need to follow to get covered services and prescription drugs. A copy of the Evidence of Coverage is included in this envelope. Visit our Website You can also visit our website at https://or.healthnetadvantage.com. As a reminder, our website has the most up-to-date information about our provider network (Provider Directory) and our list of covered drugs (Formulary/Drug List). Section 8.2 Getting Help from Medicare To get information directly from Medicare: Call 1-800-MEDICARE (1-800-633-4227) You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. Visit the Medicare Website You can visit the Medicare website (https://www.medicare.gov). It has information about cost, coverage, and quality ratings to help you compare Medicare health plans. You can find
Health Net Violet 1 (PPO) Annual Notice of Changes for 2018 17 information about plans available in your area by using the Medicare Plan Finder on the Medicare website. (To view the information about plans, go to https://www.medicare.gov and click on Find health & drug plans. ) Read Medicare & You 2018 You can read Medicare & You 2018 Handbook. Every year in the fall, this booklet is mailed to people with Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare. If you don t have a copy of this booklet, you can get it at the Medicare website (https://www.medicare.gov) or by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.